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Am Fam Physician. 2001;63(6):1048-1050

to the editor: Why does the American Academy of Family Physicians (AAFP) advocate performing Papanicolaou (Pap) tests in all women at age 18 regardless of their sexual activity status? The young woman who presents without a history of previous sexual activity does not need to undergo a Pap test. The Pap test is a screening test for cervical cancer and precancerous conditions. Human papillomavirus (HPV) is virtually the sole cause of cervical cancer and is sexually transmitted. The woman who has had no sexual experience is at extremely low or no risk for cervical cancer. Why advocate screening in this group?

Another area that puzzles me is Pap screening in women who have undergone total hysterectomy. I see this testing being done in clinics and observe physicians who say, “Just do it” to residents in training, but I do not see the point. These women have no cervices. What is the purpose of a screening test when the organ is not present? I am aware that, occasionally, vaginal abnormalities are discovered; a high degree of suspicion may be present from the physical examination and/or history in these cases. The Pap test then becomes a test to confirm an abnormality found on physical examination—not a screening test.

Finally, why continue Pap test screening in women older than 65 years who have no sexual contact or who have had the same partner and many previous Pap tests that were within normal limits?

I stress that in all these situations, I speak of performing screening Pap tests as probably being performed unnecessarily, and do not refer to those persons where the medical history and physical examination prompts the physician to conduct appropriate testing.

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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